Tuesday

Nov 20, 2018 at 2:04 PMNov 20, 2018 at 3:01 PM

We are amidst a healthcare shift as many healthcare specialists are managing the growing aging population. Physical therapists are rising to take on additional roles in your healthcare team. Traditionally, people have come to physical therapy after injuries, surgeries, hospitalizations or diagnoses of diseases such a Parkinson’s disease or multiple sclerosis. Recently an area that is receiving a tremendous amount of attention is associated with the “opioid crisis,” chronic pain and alternatives to pain medication for the treatment and management of pain.

Locally and nationally, the American Physical Therapy Association and physical therapists are partnering with physicians, healthcare practitioners and administrators to address how movement is critical to the process of empowering and enabling patients to take a more active role in their health and reducing disability. The functional cost and penalty of not moving is recognized as creating a serious toll on an individual’s mental, physical and emotional well-being.

We all have activities and functions to perform every day of our lives. The spectrum of activities is as varied as there are people on the earth. In other words, the activities and daily functioning of people may range from simply getting out of bed and dressing to highly competitive activities and everything in between.

When it comes to chronic pain and the associated decreased activity and deconditioning, an individual should throw the myth of “no pain no gain” out the window. This concept is outdated with roots in an oversimplified concept of fitness and exercise training of years gone by. The premise was that you had to “tear something down” and that would somehow allow your body to build something up, like muscle. Well, the shred of truth behind this myth is that our bodies adapt and change under the demands we put on them. Exercise science tells us that we as human beings, our bodies and minds, adapt to the conditions and stressors that we place upon ourselves. For example, to grow bigger muscles and coordinated movements, we need to train, not traumatize ourselves. Methodical and regularly exercise over time with good nutrition it the key; nothing is magic.

When people initially have pain, it is when there is damage to tissues. Pain is one of the body’s normal alarm systems warning us to rest and allow the injured tissues to heal. Sometime the body’s alarm system continues to go off after tissue healing time is complete. Over time and under certain circumstances, the body’s alarm system becomes too sensitive and goes off when no injury is happening, creating fear or apprehension of movement. This kind of pain and fear of movement results in a wiring change in the brain. When this kind of change happens in our brain and our pain system is operating out of its normal functioning, it can set the stage for significant lifestyle changes for the worse.

With current chronic pain theory and management, physical therapists are teaching and enabling patients to understand and implement a mind – body process to cope with pain. After a physical therapy evaluation, the patient begins with prescriptive activities and movements that do not set off alarm bells in their bodies and minds that have stopped them from moving, functioning and living. Each person’s alarms are both in the body and brain (nervous system) and with gradual and consistent movement the individual can retrain their body, mind and spirit.

Fear of movement that will cause pain and the apprehension this creates is a very complex mechanism in humans. The takeaway is that a maladaptive (bad) process has taken place, which has lowered the setting at which a person’s pain alarm goes off and they stop moving. The physical therapy solution is a concept of graded exposure, which means regular, methodical introduction of an increase in activity and movement over nature’s time frame. Through this process of graded exposure an individual gradually raises, reshapes and remodels their spirit, body and mind; thereby recapturing their lives. This is an active process of education, understanding and activity, with the patient participating in each step. Graded exposure is how the patient and physical therapist move forward. There is hope and it is not a passive, sit back and relax and let it happen process.

In our current society time is measured in seconds, minutes, hours, deadlines, emails, texts and phone calls. Our physical bodies are more primitive than that; meaning training our bodies and minds using good nutrition with activity and movement simulates change for the better over time. Common phrases such as “one step at a time “, “do the next right thing”, and “a journey of a thousand miles starts with the first step, is how we proceed with movement and active participation in our own health and well-being. The physical therapists at Spaulding Framingham Outpatient center are trained and here to help.

Jeff Smith PT, DPT, MS, MEd is an Advanced Clinical Specialist at Spaulding Outpatient Center Framingham and an Alumni of Springfield College, University of Massachusetts / Lowell and Simmons College. He has over 25 years treating patients with a variety of orthopedic and musculoskeletal diagnoses.